My demeanor is too dependent on the patient..

[herewego]

Semi-rant but also a call for advice from more seasoned ED docs out there.

I'm an intern. I get along well with most patients. If they're even half reasonable human beings, in distress, or kiddos, I've got genuine sympathy for them and my demeanor reflects that.

But I guess I"m not great at hiding annoyance and frustrating yet. Case and point today. 60+year old lady, multiple abdominal surgeries coming in for abdominal pain. Seems with it, says her pain is 10/10 (doesn't look like it, you know exactly what I'm talking about), but I give her the benefit of the doubt because shes had some real pathology in the past. I start doing the physical exam, and I say "Ok I'm going to push down on your belly, you let me know if it hurts more when I push or when I let go." I proceed to do that probably 10 times, without her actually answering the question with anything remotely close to "when you push down" or "when you let go." I get frustrated and my tone changes to show some annoyance. Daughter at bedside calls me out, says I need to work on my bedside manner because her mother is in pain. Fair enough, I showed annoyance.

I can see that I'm at fault for showing the annoyance, but I also think a grown woman AOx3 should be able to answer a question after 10 tries, and that at some point they should be treated as an adult and not a baby.

Thoughts? What goes through your head when you're in these kind of situations? Does it get to you?

---

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[Hair Police]

Maybe she's hard of hearing. Maybe you're not explaining it correctly, or she doesn't understand what you're asking for, or she can't physically tell the difference. The fact that she let you do it ten times should tell you something. I might give someone three tries at a test, but if they can't do it, I document as such and move on. You can usually get the same or similar info another way. If your attending is pissed you can't get peritoneal signs out of her after ten tries, then that's on them.

I don't usually ask the patient "Which feels worse" - I do the exam and watch their reaction. If they cringe them I might ask to confirm.

Try not to get angry at work - I see you're an overworked intern and it's hard, but I see colleagues get angry again and again and it becomes a poison. They start to not want to come into work, they offend colleagues and consultants. Being adaptable in many situations and working with difficult patients is part of the job.

 

[Birdstrike]

Just do your exam. All this explaining, asking, rebound this, rebound that....don't waste your time.

Quick history. Push on the belly to get a quick sense for the amount of tenderness. Order your tests. Smile and go. You will have plenty of patients or family members that are stressed, irritated, on edge, whatever. They're irritated, every single one of them, because they're in the FRICKIN' ER, not because of you. Irritated patients and families are the rule in the ED. Be water, not fuel, to that fire. Which are you going to be? Choose now.

After you've examined 500 abdomens, you're going to learn to know within the first 3 seconds of your exam how much peritonitis there is, or isn't.

I know it's hard, and you don't want to be too emotionally detached, but to a large extent you have to get very clinical, not quite robotic, but clinical enough that you're just doing it.

Family is annoyed? Okay. Quick smile. "Oh, I'm sorry. No harm intended. I'm glad she came in. We're going to get right on this and order some tests, right away." Learn it. Script it. Rehearse it.

Patient says, "F--- you, I ---- hate this ----ing place!"

You,

Quick smile. "Oh, I'm sorry. No harm intended. I'm glad she came in. We're going to get right on this and order some tests, right away."

Family member says, "I'm going to sue the ---- out of you and this ----ing hospital!"

You,

Quick smile. "Oh, I'm sorry. No harm intended. I'm glad she came in. We're going to get right on this and order some tests, right away."

Just a ripple in the water, man. You'll have much bigger fish to fry.

Loosen up a little bit. Keep moving from patient to patient. Don't obsess about getting the perfect physical exam as it's often impossible due to patient lack, or inability of, cooperation. History is most important, anyways. Don't waste your time checking rebound 10 times.

In this patient, all you need is two historical facts:

"60 yrs old" + "abdominal pain" = Labs, UA, CT and/pelvis, ekg

DONE

Quick glance at BP & HR to make sure not crashing from a AAA or horrendous signs of peritonitis.


"Next..."

 

[herewego]

I appreciate the responses, truly. Its the kind of advice I needed to hear. Thank you.

 

[Janders]

Good advice.

One think I do, initially organically and now out of habit, is to ask every patient one non-clinical question. Or at least only vaguely clinical question. Usually while I am pressing on their belly or washing my hands.
"What do you do for a living?"
"Did you grow up around here?"
"Where is your accent from?/That is an interesting name, where is it from originally?"

(Perhaps this is just a Southern mannerism...)

Sometimes this IS clinically relevant (occupation matters with injury, etc). But my goal is just to add a touch of humanity to our conversation. It gives me one fact to put in my note that shows I DID converse with them. It often leads to a 30 second conversation about their job, etc. This often deflates tension in those tough rooms. You get that sense after 20-30s they are overly frustrated to be in your ED? Slow down, smile, ask them something about themselves... its very disarming.

And, all cynacism aside, sometimes people ARE really interesting, and you can take 2 minutes and sit down and chat with them. Gotta find the nice moments in a hectic day, you know?

 

[Birdstrike]

Good advice.

One think I do, initially organically and now out of habit, is to ask every patient one non-clinical question. Or at least only vaguely clinical question. Usually while I am pressing on their belly or washing my hands.
"What do you do for a living?"
"Did you grow up around here?"
"Where is your accent from?/That is an interesting name, where is it from originally?"

(Perhaps this is just a Southern mannerism...)

Sometimes this IS clinically relevant (occupation matters with injury, etc). But my goal is just to add a touch of humanity to our conversation. It gives me one fact to put in my note that shows I DID converse with them. It often leads to a 30 second conversation about their job, etc. This often deflates tension in those tough rooms. You get that sense after 20-30s they are overly frustrated to be in your ED? Slow down, smile, ask them something about themselves... its very disarming.

And, all cynacism aside, sometimes people ARE really interesting, and you can take 2 minutes and sit down and chat with them. Gotta find the nice moments in a hectic day, you know?

Good point. Good post

 

[RuralEDDoc]

As a corollary to the above post on asking a non-clinical question: All of my abdominal exams are done while distracting the patient.
Try this: Walk in the room; take history; listen to heart and lungs, then listen to the belly with your stethoscope. Gently push on the abdomen with the stethoscope. I don't give two ****s if they have bowel sounds, but I do care if they are tender when the stethoscope touches the belly.
Take off the stethoscope, then ask them about what they do for a living/the local community event/sporting event/some other BS. Once properly distracted, push on the quadrant farthest from the reported pain. Work your way to the point of pain. Keep them talking. See how they react.
Never start with "does this hurt?" and then push on the abdomen. The answer is always going to be yes.
This technique allows you to assess for focal tenderness and peritonitis, but you have to keep abdominal catastrophies on the differential that don't always cause tenderness, such as mesenteric ischemia, internal hernia, infected renal stone, volvulus, etc.

 

[link2swim06]

It's all about their reaction to the exam. It's suppose to be objective.

Them tell you something is a subjective piece of information that belongs in the hpi.

 

[Cerberus]

After you've examined 500 abdomens, you're going to learn to know within the first 3 seconds of your exam how much peritonitis there is, or isn't.

this

 

[EM4life]

I can see that I'm at fault for showing the annoyance, but I also think a grown woman AOx3 should be able to answer a question after 10 tries, and that at some point they should be treated as an adult and not a baby.

This is a thought that you will have often treating patients in the ED, it will also seriously bite you in the butt if you show it. Even the most uneducated, drug addicted, drunks often will have the emotional competence to sense your annoyance - this will make your job harder and make it incredibly difficult for them to trust anything you say. Don't show it, ever. If I get some inkling that a patient has this sense of distrust, I will often go out of my way to show that I do care about them, whether its just sitting down and giving them more time or grabbing a blanket or offering to adjust their bed or flipping the lights. I'm not about to get sued because I did every thing right for a patient but they sued me because they sensed that I was annoyed or thought I didn't care, not to mention they are less likely to listen to whatever your treatment plan is if they don't think you give two craps - my two cents

Edit: An adult should be treated as an adult but if they are acting like a baby and in their 50s...they didn't get that way overnight and it is unlikely that your interaction with them is going to change things.

 

[Rendar5]

It's all about their reaction to the exam. It's suppose to be objective.

Them tell you something is a subjective piece of information that belongs in the hpi.

and this.
The only time to ask if it hurts when you palpate an abdomen is if you can't tell if they're reacting to pain or tenderness. In general, I chat with them while pressing and just look at facial expressions for a grimace. And if I'm looking for rebound, I just take my hand off quick and see if they grimace more when they're surprised it hurts.

 

[gman33]

A quick exam will tell you all you need to know.
You are most likely getting imaging or other tests anyway.
Don't repeat potentially painful exams that aren't going to change anything.

The less time you spend in the room, the less likely you will show negative emotions.

If you find yourself getting pissed off, make up any excuse to leave the room.
Come back when you calm down.

 

[turkeyjerky]

There's a lot of great advice in this thread. I struggle with this problem as well, and although I've made great strides with it during residency, every once in a while my annoyance with some of these dingbats breaks through. A few key points:
--don't waste time/energy trying to get data points that won't alter your management. This is easier once you are more senior, when you won't have to prove your thoroughness to an attending who doesn't trust you. A large portion of our patients are just incapable of providing a decent history, it's not their fault--they're doing the best the can, only their best still sucks
--if the patient is accompanied by their adult children, then treat the patient like the child and the children like the parents. Ditto if the patient brought a friend who does most of the taking. These people have shown you that they are not acting as their own primary decision makers
--One trick I've taken too is to say thank you profusely, for just about everything. I thank them for waiting so long to see me (i think this works better than apologizing for the wait), I thank friends/family members for coming along, I thank them for saying I look too young/short/goodlooking/disheveled to be a doctor. For the repeat customers w/ chronic unexplained symptoms, I end the encounter by thanking them for coming back to see us. I find this both increases my empathy for them, as well as defuses them.

 

[DocVirk]

Good advice.

One think I do, initially organically and now out of habit, is to ask every patient one non-clinical question. Or at least only vaguely clinical question. Usually while I am pressing on their belly or washing my hands.
"What do you do for a living?"
"Did you grow up around here?"
"Where is your accent from?/That is an interesting name, where is it from originally?"

(Perhaps this is just a Southern mannerism...)

Sometimes this IS clinically relevant (occupation matters with injury, etc). But my goal is just to add a touch of humanity to our conversation. It gives me one fact to put in my note that shows I DID converse with them. It often leads to a 30 second conversation about their job, etc. This often deflates tension in those tough rooms. You get that sense after 20-30s they are overly frustrated to be in your ED? Slow down, smile, ask them something about themselves... its very disarming.

And, all cynacism aside, sometimes people ARE really interesting, and you can take 2 minutes and sit down and chat with them. Gotta find the nice moments in a hectic day, you know?

Great advice. Sometimes this is the best part of my day. I have met people who worked at NASA during the moon landing, who escaped from the Nazis, and who have some of the most interesting stories. I also meet a lot of boring people. But it disarms people, makes them feel like you are interested, and once people start talking about themselves and loosen up, a lot of tension can be defused. On days when I don't get to resuscitate people, sometimes my favorite episodes are the guy with diverticulitis who flew planes during world war II. Learning belly exams is a lot easier than learning how to interact with people. Practice both.

 

[Old_Mil]

Remember that a good portion of EM is psychiatry with a stethescope.

That percentage increases when dealing with middle aged women with belly pain.

They still get the Birdstrike workup prior to discharge.

60 isn't old enough for the drug seekers to have self selected themselves out of the gene pool, but it is long enough for them to have distilled their unpleasantness like a bottle of old whiskey.

 

[Lawgiver]

i can tell you need to work in a call center for a bit.

 

[Birdstrike]

Remember that a good portion of EM is psychiatry with a stethescope.

That percentage increases when dealing with middle aged women with belly pain.

They still get the Birdstrike workup prior to discharge.

60 isn't old enough for the drug seekers to have self selected themselves out of the gene pool, but it is long enough for them to have distilled their unpleasantness like a bottle of old whiskey.

The Birdstrike work up? What? Lmao

"Self select out of gene pool"? Lol. That's great. Lmao

 

[Cerberus]

Don't repeat potentially painful exams that aren't going to change anything.

My disagreement with this - after sitting on countless quality improvement meetings - is that you should absolutely reassess their belly if you are concerned or more importantly if they are being discharged. I never discharge a belly pain without documenting a repeat abd exam. On the CQI side I've seen too many go south despite a benign normal assessment. I have seen enough doctors get toasted by this...

 

[Birdstrike]

My disagreement with this - after sitting on countless quality improvement meetings - is that you should absolutely reassess their belly if you are concerned or more importantly if they are being discharged. I never discharge a belly pain without documenting a repeat abd exam. On the CQI side I've seen too many go south despite a benign normal assessment. I have seen enough doctors get toasted by this...

This is so important. Never send a belly pain home with out a documented repeat exam prior to discharge. Confirms you checked for and documented lack of evidence of progression of serious disease. Not a total rule out, but medical-legally big, and good medical practice, too.

 

[gman33]

Agree with the repeat exam prior to d/c.
My statement was meant in the context of the OP pushing repeatedly on the initial assessment.

 

[Hair Police]

The "killing them with kindness" approach really does work, both on the drug seekers and the constantly curmudgeonly consultant.

Almost everything we do should follow the algorithm of: find/diagnose an issue, treat the problem, and prove that you have solved the problem. For example, belly pain->gastroenteritis->IVF/meds/etc.->repeat exam and tolerating PO->DC.

If they fall out of the algorithm, they get admission +/- consultant. Belly pain->Dx appy-> surgery.

Belly pain->gastro->meds->medsx2->not tolerating PO or orthostatic->admit

And so on.

 

[WilcoWorld]

The Birdstrike work up? What? Lmao

"Self select out of gene pool"? Lol. That's great. Lmao

Yeah, but neither one beats "distilled their unpleasantness like a bottle of old whiskey."

 

[WilcoWorld]

In this patient, all you need is two historical facts:

"60 yrs old" + "abdominal pain" = Labs, UA, CT and/pelvis, ekg

DONE

Quick glance at BP & HR to make sure not crashing from a AAA or horrendous signs of peritonitis.


"Next..."

I take great offense at this post. Your workup is oversimplified and not based on the evidence.

Sometimes, I get an ultrasound instead of a CT.

 

[Birdstrike]

I take great offense at this post. .

Are you joking? Lol

Of course it's "simplified." Not all my posts can be 1,500 word dissertations covering all possibilities or valid ways to skin a cat. Who cares what I think anyways? I certainly don't.

 

[deleted171991]

Good advice.

One think I do, initially organically and now out of habit, is to ask every patient one non-clinical question. Or at least only vaguely clinical question. Usually while I am pressing on their belly or washing my hands.
"What do you do for a living?"
"Did you grow up around here?"
"Where is your accent from?/That is an interesting name, where is it from originally?"

(Perhaps this is just a Southern mannerism...)

Sometimes this IS clinically relevant (occupation matters with injury, etc). But my goal is just to add a touch of humanity to our conversation. It gives me one fact to put in my note that shows I DID converse with them. It often leads to a 30 second conversation about their job, etc. This often deflates tension in those tough rooms. You get that sense after 20-30s they are overly frustrated to be in your ED? Slow down, smile, ask them something about themselves... its very disarming.

And, all cynacism aside, sometimes people ARE really interesting, and you can take 2 minutes and sit down and chat with them. Gotta find the nice moments in a hectic day, you know?

Yeah, it's so nice to feel discriminated against based on accent/region/nationality... Not only does the latter go against the Civil Rights Act (I bet you don't ask patients about their religion, especially if different than yours, unless pertinent), but it's completely unprofessional. Yet I still see it all the time.

 

[WilcoWorld]

Are you joking? Lol

Of course it's "simplified." Not all my posts can be 1,500 word dissertations covering all possibilities or valid ways to skin a cat. Who cares what I think anyways? I certainly don't.

Yes, totally joking.

 

[VA Hopeful Dr]

Yeah, it's so nice to feel discriminated against based on accent/region/nationality... Not only does the latter go against the Civil Rights Act (I bet you don't ask patients about their religion, especially if different than yours, unless pertinent), but it's completely unprofessional. Yet I still see it all the time.

Ummm.... I hope this is sarcasm

 

[deleted171991]

Ummm.... I hope this is sarcasm

No, it's not. Every immigrant knows s/he has an accent and a foreign-sounding name, both of which are disadvantageous. One does not need his/her doctor to remind one about it.

It's not nice. It's actually insensitive. Now asking about occupation, kids etc. is much better, although I personally don't appreciate those questions either (the physician is in a power position, and the patient cannot really answer with "none of your business"). If you want small talk, talk about the weather.

There is a big difference and a fine line between being perceived as nice or intrusive.

 

[VA Hopeful Dr]

No, it's not. Every immigrant knows s/he has an accent and a foreign-sounding name, both of which are disadvantageous. One does not need his/her doctor to remind one about it.

It's not nice. It's actually insensitive. Now asking about occupation, kids etc. is much better, although I personally don't appreciate those questions either (the physician is in a power position, and the patient cannot really answer with "none of your business"). If you want small talk, talk about the weather.

As a guy from SC who is seeing a doctor in New Jersey and routinely gets asked about his accent - calm down. Its the easiest way to figure out that someone isn't local and opens up conversation about where they are from. No one is judging based on the accent, its just making conversation.

Also, as my wife and I are on IVF cycle #3 with no kids, I find THAT question insensitive. (Not really, but the point is still valid)

 

[deleted171991]

As a guy from SC who is seeing a doctor in New Jersey and routinely gets asked about his accent - calm down. Its the easiest way to figure out that someone isn't local and opens up conversation about where they are from. No one is judging based on the accent, its just making conversation.

It might feel like making conversation, if you were born in the US, and have a different regional accent. If you are an immigrant, it can feel (or even be) discriminating.

So please don't tell me to calm down.

 

[VA Hopeful Dr]

It might feel like making conversation, if you were born in the US, and have a different regional accent.

The fact that you are telling me to calm down shows how culturally-insensitive and indifferent you actually are.

You seem to be assuming that any of us care that you aren't born in the US. I assure you, we don't. If I comment on you accent, its a prelude to being honestly curious about your country of origin - that's all.

 

[deleted171991]

You seem to be assuming that any of us care that you aren't born in the US. I assure you, we don't. If I comment on you accent, its a prelude to being honestly curious about your country of origin - that's all.

You might not, but many others do subconsciously (there are enough studies about interview rates for resumes with minority/foreign-sounding names, vs WASP names). That's why some people change their names upon naturalization.

If there were no discrimination, people would not Americanize their Chinese first names, for example.

It is natural, so I don't mind. I just don't appreciate being reminded about it by my doctor, especially if not an immigrant himself/herself.

 

[VA Hopeful Dr]

You might not, but many others do (there are famous studies about interview rates for resumes with minority/foreign-sounding names, vs WASP names). That's why some people change their names upon naturalization.

If there were no discrimination, people would not Americanize their Chinese first names, for example.

That's interviewing for a job, and I certainly don't argue that there is discrimination in that arena (and many others) - and even as a white conservative Southern male, I wish that wasn't the case.

But that's not what we're talking about here. This is purely about exchanging pleasantries with patients. No one here is going to deny pain medicine because you sound like you're from Mongolia, or not give you antibiotics because your accent seems Indian.

 

[Janders]

If it makes you feel better, I only use the accent question on people with REGIONAL US ACCENTS. I have one. At least 1/3 of my patients ask where I'm from (I'm not a local...). I agree, asking someone who speaks English with a strong foreign accent, or as a second/third/18th language about their "accent" might be a bit rude!

Same thing with the "interesting name". I, a white man, don't walk up to patients who are obviously foreign / minority and say "you have a funny name! where in the world is it from!?!". That is rude, and insensitive. Duh. Now I do occasionally ask older, caucasian people with odd surnames about the origin. Often its a name from the old country and often there is some pride / history behind it.

Now someone who is obviously an immigrant, sometimes I do ask where are they originally from. It IS medically relevant for a number of reasons. It is also relevant how recently they travelled abroad and where.

Now I think what you truly bring up, is that ANY question can offend ANYONE. You described me as both discriminatory and unprofessional. Obviously this strikes a nerve. I don't desire to be either of these things.

I think the key with ANY question you ask, is to ask it without prejudice, and with an interested smile on your face. Also your answer matters...

If I ask someone where they originally were from, and they say "Haiti". I say, "I've been there twice. The people were so wonderful and kind to me. Have you been back recently?".

Other things I talk about with patients sometimes, which hopefully aren't discriminatory or unprofessional--
--I talk to people about food. I like to eat. I like to eat things around the world. This can be a nice way to connect with someone from another culture. I've gotten good recipes and good restaurant recs.
--If they have the TV on in the room, you can talk about the (often sports) that are on.
--The weather. Everyone likes to bitch about snow!
--Video games! Never offended a 13yo boy by asking if he's into xbox or playstation

Things I tend to avoid:
--I do tend to avoid religious discussions, but have awkwardly joined in a number of prayers from a number of religious. Seemed OK at the time.
--Politics is a bit easier to navigate... I let people talk about their opinion without really getting involved. But I don't bring it up myself.
-- Healthcare billing and reform. Aside from explaining how I don't make the obs/admit rules and I totally agree they are a crock of crap.

 

[deleted171991]

That's interviewing for a job, and I certainly don't argue that there is discrimination in that arena (and many others) - and even as a white conservative Southern male, I wish that wasn't the case.

But that's not what we're talking about here. This is purely about exchanging pleasantries with patients. No one here is going to deny pain medicine because you sound like you're from Mongolia, or not give you antibiotics because your accent seems Indian.

If it's not pertinent to the patient's disease, it's about as appropriate as remarking that the patient is good-looking.

My point is that medical students and residents should be very careful in asking/writing down any non-pertinent information that might be perceived as discriminating (for example, in Court), especially if the doc has a pattern.

 

[VA Hopeful Dr]

If it's not pertinent to the medical history, it's about as appropriate as remarking that the patient is good-looking.

My point is that medical students and residents should be very careful in asking/writing down any non-pertinent information that might be perceived as discriminating (for example, in Court), especially if the doc has a pattern.

Of course we're not writing it down, much like I don't write down about the patients' dogs or how old their kids are - doesn't mean that asking about it is forbidden.

 

[deleted171991]

Of course we're not writing it down, much like I don't write down about the patients' dogs or how old their kids are - doesn't mean that asking about it is forbidden.

My point is: Don't ask anything you wouldn't feel comfortable writing down.

Dogs are fine. Kids are fine. Etc.

And if the geographical area/nationality is important for the genetics of my disease, and only then, ask closed-ended questions. Not "where are you from?", prefaced or not by "Do I hear an accent?".

 

[VA Hopeful Dr]

My point is: Don't ask anything you wouldn't feel comfortable writing down.

Dogs are fine. Kids are fine. Etc.

Did you miss my point about kids not being fine for everyone?

 

[deleted171991]

Did you miss me point about kids not being fine for everyone?

I apologize, I had missed your point. It was not intentional.

 

[Zebra Hunter]

If it's not pertinent to the patient's disease, it's about as appropriate as remarking that the patient is good-looking.

My point is that medical students and residents should be very careful in asking/writing down any non-pertinent information that might be perceived as discriminating (for example, in Court), especially if the doc has a pattern.

Is it cool if I stated that the patient shared a piece of his birthday German chocolate cake with me? I like having a small bit of color in my notes. Makes it feel less monotonous when I'm filling out daily progress notes on a patient that's been stuck on our service for 2 weeks.

 

[VA Hopeful Dr]

It definitely might not be fine for the patients who can't have one.

But that's not protected by law.

Neither is me asking "where are you from"

 

[engineeredout]

Our best bet is to not speak to anyone else in the entire world at all because they might get offended

 

[shoal]

Ffp ur so frickin sensitive its saddening. This job is hard enough without someone adding more rules ontop, one must maje it through the day and one way is getting to know your patients and if that is asking where theyre from, so be it. It may be medically relevant. As stated previously, discrimination isnt happening on the context on your accent, i will treat tyou the same as joe blow next door.

I figured why not feed the troll more, im enjoying the rant

Sent from my LG-D801 using Tapatalk

 

[TooMuchResearch]

It might feel like making conversation, if you were born in the US, and have a different regional accent. If you are an immigrant, it can feel (or even be) discriminating.

So please don't tell me to calm down.

Then how about calm down because in the ED where a person is from is often a pertinent question? Or asking a person with a heavy accent if they're more comfortable using an interpreter?

 

[deleted171991]

Then how about calm down because in the ED where a person is from is often a pertinent question?

It's rarely, not often. Travel history yes, but genetic makeup no. There are very few non-infectious diseases with increased geographic frequency.

"So, tell me, where is your diabetes from?"

Or asking a person with a heavy accent if they're more comfortable using an interpreter?

If you want to add insult to injury.

I ask only when I feel that one of us has trouble understanding the other. That's pertinent. A patient might have a bad accent and still speak English fluently.

Listen, this is just my opinion, as somebody who knows firsthand how it feels. You can take it into consideration, or not. But telling me to calm down is rude.

 

[throckmortonDO]

oy vey.

back to the OP's question.

What do patients feel about their ED visit? Most don't even have any comprehension of the tests that you order or what any of the results mean.
Think about how many times you've heard the phrase " well they didn't even do anything for me".
to them, they went through a tube, got some blood drawn, and now here's a 'young looking doctor' telling them that 'nothing major is wrong' and they are being dc home.
sure, you did do ALOT for them, but how did they FEEL about it? communication is not at all about what you say, but what they hear.
There is definitely quite a bit of 'acting' necessary, whether you like the idea of this or not.

Think about this... you just finished coding a patient in the next room who didn't make it. worse if it was a peds case. now you have to pull yourself together and go talk to the ESI 4 likely gastroenteritis/knee pain/work note/dental pain/vag discharge in the next room who has been waiting 3 hrs to be seen and is now irritated. You have to go in there, 'forget' what just happened next door, keep your composure, act like you care, and get the interview over with.

It's not easy. Its probably one of the hardest parts of your job. Believe me I know, I struggled with it too at first. Unfortunately these days you can't be a brilliant Dr House with the demeanor of a gremlin. Press Ganey is here to stay, and most patients judge you on your bedside manner as to whether they felt like you 'did a good job'. Like said above, if you buy into the bitterness it will kill you. if you feel stressed take a 10 second breather, put your head down for a minute, take a deep breath, put on your best face, and go into the next room. The most 'successful' attendings I know are not the best clinically, but they act like a duck on the outside, cool, calm, collected, super friendly, not stressed, let it roll off your back. Under the surface? paddling like hell. Like I said..a Duck.

should you make small talk with a patient? I suppose, if you feel like there is an opportunity to do so and its noninvasive. Obviously everyone can be offended by something.
try sitting during the interview. introduce yourself to everyone in the room.

I use the birdstrike approach when I feel like it will help. " I'm sorry to hear your not feeling well, lets try to get you better and figure out whats going on, let me know if you need anything, we are here to help", then keep it moving.

 

[TooMuchResearch]

It's rarely, not often. Travel history yes, but genetic makeup no. There are very few non-infectious diseases with increased geographic frequency.

"So, tell me, where is your diabetes from?"

If you want to add insult to injury.

I ask only when I feel that one of us has trouble understanding the other. That's pertinent. A patient might have a bad accent and still speak English fluently.

Listen, this is just my opinion, as somebody who knows firsthand how it feels. You can take it into consideration, or not. But telling me to calm down is rude.

I ask if I get any sense they aren't 100% comfortable doing a medical interview in English.

 

[AmoryBlaine]

I'm probably a minority opinion on this but I think it's fine for the OP to get frustrated and show it.

We validate far to much absolutely horrible behavior from patients. Refusing to answer simple questions from a doctor who you came in to see is awful. If you are in too much pain to talk, I understand that, but most of these patients are not.

I have ejected multiple patients for failing to cooperate with the history and physical. Obviously you have to select your candidates pretty carefully here but recently I had a 21 f come in for "syncope" by EMS who wouldn't talk at all. Just sat on bed and stared at us. Asked her several times, verified she spoke english, etc. Then I said very clearly: "you can either answer my next question or I am going to removed by security and document that you are attempting to defraud the hospital and the EMS system so that your insurance will not pay for this visit. The other option is that I can have you committed to a psych facility. There is no 3rd option. Now why are you here?" All of a sudden her ability to talk returned.

If patients will not fully participate then I just leave the room and wait a minimum of an hour before going back it. When teh family comes out saying they need pain medicine/juice/sammich I say, "sorry, your mother hasn't allowed us to evaluate her so we can't treat her yet."

I don't think we have a duty to haul information out of people. We have a duty to provide care but if the patient isn't on board there isn't much we can do.

I worked with a guy at one of my ML gigs who takes it a step further. He tells a lot of patients, "you made a really bad decision today to come to the ER." He gets lots of complaints but he also gets tons of compliments and is probably the staff's #1 favorite doc.

 

[engineeredout]

Nothing makes me more angry, more likely to yell at the patient, more likely to throw furniture, then when you go see a patient who is usually in the ED for some bull**** complaint like vaginal discharge at 3am, but they cannot be bothered to open their eyes to talk to you. They simply don't want to wake up. You are disturbing them by waking them up and attempting to ask about why you're here. Last night I have one for 3am vaginal discharge X 2 days who when I tried to talk to her took a blanket and pulled it over her head. I come back with the nurse to do the pelvic, and the same ****. She does not want to wake up. We tell her (loudly) that she needs to wake up and participate in the exam or we are not going to treat her. Still with eyes closed she just spreads her legs and lifts them up wide in the air.

I'm disgusted with humanity.

 

[Birdstrike]

I'm probably a minority opinion on this but I think it's fine for the OP to get frustrated and show it.

We validate far to much absolutely horrible behavior from patients. Refusing to answer simple questions from a doctor who you came in to see is awful. If you are in too much pain to talk, I understand that, but most of these patients are not.

I have ejected multiple patients for failing to cooperate with the history and physical. Obviously you have to select your candidates pretty carefully here but recently I had a 21 f come in for "syncope" by EMS who wouldn't talk at all. Just sat on bed and stared at us. Asked her several times, verified she spoke english, etc. Then I said very clearly: "you can either answer my next question or I am going to removed by security and document that you are attempting to defraud the hospital and the EMS system so that your insurance will not pay for this visit. The other option is that I can have you committed to a psych facility. There is no 3rd option. Now why are you here?" All of a sudden her ability to talk returned.

If patients will not fully participate then I just leave the room and wait a minimum of an hour before going back it. When teh family comes out saying they need pain medicine/juice/sammich I say, "sorry, your mother hasn't allowed us to evaluate her so we can't treat her yet."

I don't think we have a duty to haul information out of people. We have a duty to provide care but if the patient isn't on board there isn't much we can do.

I worked with a guy at one of my ML gigs who takes it a step further. He tells a lot of patients, "you made a really bad decision today to come to the ER." He gets lots of complaints but he also gets tons of compliments and is probably the staff's #1 favorite doc.

Let's pause and give a standing ovation for this post: